1. Field of the Invention
The invention pertains to the field of oral hygiene and more particularly to the irrigating, medicating and cleansing of the sub-gingival area extending from the gingival crest to the attachment apparatus at the base of the gingival pocket or gingival sulcus.
2. Description of the Prior Art
A periodontal interproximal region is formed by two contacting teeth which create an embrasure space apical to the contact area and a sluce-way coronally. Within the embrasure space are located the gingival papilla, whose mesial and distal surfaces form the gingival sulcus. The sulcus has an integral gingival surface composed of non-keratinized unattached gingiva and terminates at the beginning of the tooth's attachment apparatus. This area, beginning at the gingival margin and extending to the base of the attachment apparatus, including the mesial and distal aspects thereof, is referred to herein as the "sub-gingival region". In healthy gingiva the distance from the coronal gingival margin to the attachment apparatus is generally between 1 and 3 millimeters. Because of the shape of the periodontal interproximal area, food and bacteria may accumulate between the teeth and penetrate deep into the gingival sulcus. If the bacteria are allowed to remain in the sulcus, a complex structure (sulcular flora) forms and the tissue becomes inflamed. This inflammation of the gingival tissue is associated with gingival bleeding and hallotosis and is called gingivitis. If any of the known periopathic bacteria are part of the sulcular flora, the attachment apparatus becomes damaged and a complex immuno-pathological event occurs that causes continued loss of attachment, osteoclasia and periodontal pocket formation. This condition is called periodontitis which is the leading cause of tooth loss in adults. Numerous studies have shown that periodontal disease can be prevented or halted when bacteria are not present or viable in the periodontal pocket. If bacterial deposits at the depths of the periodontal pocket could be neutralized every day, the periodontal attachment apparatus could be maintained and further breakdown would not occur. The problems of reaching deep into the periodontal pocket are many, the most limiting of which are:
-the teeth and interproximal areas extend deep into a small oral cavity; PA1 -the tongue limits the space of operation; PA1 -tight tooth contact does not allow easy passage of an irrigating device in a coronal apical direction; PA1 -access to the depths of the periodontal pocket is inhibited by papillary gingiva filling the region; PA1 -the irrigation device is too large to enter the depths of the periodontal pocket; PA1 -space between adjacent sub-gingival pockets is hour glass shaped; PA1 -gingival plaque adheres tightly to the sub-gingival surface; PA1 -hard deposits (calculus) on tooth interfere with penetration; and PA1 -it is difficult to penetrate the periodontal pocket without damaging hard or soft tissue.
A tooth brush, when properly used, is adequate for cleaning the facial and lingual aspects of the gingival sulcus. The bristles of the tooth brush, however, are deflected by the papilla and do not penetrate into the periodontal pocket or the mesial and distal aspects of the sulcus when the tooth brush is used against the facial or lingual surfaces. Access by the bristles to the interproximal papilla is also inhibited when in contact with the occlusal surfaces. Further, the bristles of the tooth brush are sufficiently hard to erode and lacerate the papillary tissue should sub-gingival penetration be forced. Additionally, the tooth brush is bulky and difficult to maneuver in the mouth, therefore limiting precision and pinpoint cleansing.
A curette, a metallic device which is spoon shaped for adapting to the tooth surface and having knife-like cutting edges, is presently available for reaching the sub-gingival region. Such a device, however, is difficult to use and may only be used by a professional. Even when properly used, the blade surface opposite the tooth removes the internal subgingival tissue surface, thus lacerating the tissue to cause bleeding and, almost always, gingival shrinkage or recision. These devices are rigid and different curettes must be used in the same oral cavity due to oral cavity anatomical variations. Further, this rigidity prevents the delivery of antibacterial agents during its usage.
Gum massagers, interdental stimulators and rubber tips utilized in the prior art for interproximal cleaning are too bulky to penetrate into the sub-gingival region. These devices are designed to stimulate the gingiva and to clean supragingivally (above the gum line). They are not flexible and rely on compression to achieve close contact with the teeth in the interproximal space. The combination of bulk and inflexibility generally prevents reaching the mesial lingual and distal lingual aspects of the tooth. Further, their bulk prevents deep cleaning of the sulcus or the pocket and may actually compress food and bacteria into those areas. In addition, these devices do not account for the presence of the papilla and, when inserted, deform and squeeze the papilla tightly against the tooth surface making it impossible to pass fluids into sub-gingival region.
Another device of the prior art used for interproximal cleaning is known as a periodontal pocket cleaner. This is a wooden apparatus which may splinter when forced into the interproximal area. Further, it is not flexible and can not adapt to the various interproximal tooth configurations which are encountered in an oral cavity. This device tapers to a point for insertion into the pocket. When the device is not used precisely the point may lacerate gingiva or sulcus. Cleaning is performed with a scooping action that opens the gingival sulcus and effective cleaning of the mesial lingual or distal lingual aspects of the sulcus with this device is difficult.
Another cleaning device available to the public is the well known dental floss. This thread like cleaning aid can reach the depth of the gingival sulcus and pocket and adequately clean that area. The oral cavity, however, may create serious floss access problems. Very often the dental floss must pass through contacting teeth, breaking in the process, thus providing further frustration. To pass through contacting teeth the floss must be taut and appreciable force must be applied. At times the floss snaps past the contact area to incise the gingival papilla and mutilate the tissue with considerable pain to the individual applying or having the floss applied. Moreover, it cannot deliver fluids to the sub-gingival area effectively.
Still another device of the prior art comprises a wire shaft with a multiplicity of bristles attached thereto, having the trademark PROXABRUSH. This apparatus is relatively bulky, does not fit between many teeth, and is difficult to negotiate in the oral cavity. In use, the bristles rest on the top of the papilla and are passed back and forth between teeth to cleanse the interproximal region. This action causes the papilla to erode and the penetration of the bristles within the gingival sulcus is not deep, thereby providing only partial cleansing of the interproximal area. For the device to penetrate the interproximal region, the bristle supporting wire must be thin. Thus, the wire is not sufficiently rigid or strong and distorts and often breaks in use, leaving the wire and bristles between the teeth.
Toothpicks are disclosed in U.S. Pat. No. 4,577,649 to Shimenkov (the '649 patent), the entire disclosure of which is incorporated herein by reference. In one embodiment of the '649 patent shown in FIG. 3 therein, two side faces incline toward one another so as to form an acute angle therebetween. Another embodiment shown in FIG. 4 of the '649 patent contains a third face directly connecting the two outer edges of the two side faces, thereby forming a hollow area inside. As is readily seen in FIG. 1 of the '649 patent, both embodiments discussed above are configured such that they enter and treat the gap between the teeth supragingivally, i.e., above the gum tissue. Moreover, when medication or toothpaste is dispensed from the side faces of the device, it is dipsensed directly to the teeth and above the gum line. U.S. Pat. No. 4,805,646 to Shimenkov (the '646 patent), also incorporated herein by reference, discloses a toothpick having two body portions forming an acute angle which are movable relative to one another and a spongy inner layer therebetween. The spongy inner layer is inconveniently attached by gluing to the inside of the two body portions.
It is an object of the present invention to provide a method of cleaning the sub-gingival region.
It is an object of the present invention to provide a method of cleaning and irrigating the sub-gingival region.
It is a further object of the present invention to provide a method of neutralizing plaque and bacteria through the dispensing of medicating or antibacterial agents into the sub-gingival region.
It is a further object of the present invention to provide a method of cleaning, irrigating or medicating the sub-gingival region wherein all areas of the oral cavity are accessed.
It is still a further objective of the present invention to provide a method of cleaning, irrigating or medicating the subgingival region wherein the sub-gingival periodontal irrigator does not deform.
It is still a further objective of the present invention to provide a method of cleaning, irrigating or medicating the sub-gingival region wherein the sub-gingival periodontal irrigator is guided by the dental anatomy to access the deepest aspects of the sub-gingival region.